THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMRITSAR
Consumer Complaint No. 555 of 2014
Date of Institution : 21.10.2014
Date of Decision : 15.07.2015
Smt. Jasbir Kaur Dosanjh wife of Kulbir Singh Dosanjh resident of House No. 30 R.B. Estate, P.O. Meeran kot Kalan, Loharka Road, Amritsar
...Complainant
Vs.
Tata AIG General Insurance Co. Ltd., Branch Office SCO 25, 3rd Floor, Ranjit Avenue, Opposite Green Avenue, Ajit Randhawa hospital, Amritsar ....Opp.party
Complaint under section 12/13 of the Consumer Protection Act, 1986
Present : For the complainant : Sh. G.S. Virk, Advocate
For the opposite party : Sh. P.N.Khanna,Advocate
Quorum : Sh. Bhupinder Singh, President ,Ms. Kulwant Bajwa,Member &
Sh.Anoop Sharma,Member
Order dictated by :-
Bhupinder Singh, President
1 Present complaint has been filed by Smt. Jasbir Kaur Dosanjh under the
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provisions of the Consumer Protection Act alleging therein that she obtained “Travel Guard Plan” from the opposite party on 22.4.2013 bearing Schedule No. JP218194, Producer Code No. 0009474018-020001, The complainant visited USA from 24.5.2014 to 27.6.2014. During her stay in USA, she suffered severe tooth ache and she consulted dental surgeon “Khalsa Dental Care of Gurdip Narula Dental Corporation”, 2850 Quimby Road # 145 San Jose, CA 95148 and the dental surgeon advised extraction of tooth on 18.6.2014. According to the complainant she spent US $ 945 equivalent to Rs. 58,590/- on her treatment during her visit to USA i.e. within the policy period obtained by the complainant from the opposite party. Claim was lodged with the opposite party within 24 hours after returning India by submitting all the necessary documents including schedule of Travel insurance, X-ray, detailed medical expenses, detailed copy of receipt of payment and visiting card of the clinic.. But inspite of receiving all the documents, the opposite party did not settle the claim of the complainant. Alleging the same to be deficiency in service complaint was filed seeking directions to the opposite party to pay Rs. 58590/- spent on her medical treatment in USA. Compensation of Rs. 60000/- alongwith litigation expenses were also demanded.
2. On notice, opposite party appeared and filed written version in which it was submitted that complaint is premature as the opposite party had been demanding the credit card statement reflecting the amount alleged to have been paid in USA
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150 US $ , 750 US $ and US $ 45 on telephone, which the complainant has not supplied till date. It was however, submitted that liability of the opposite party is limited to US $ 300 subject to submission of credit card statement which the complainant has not submitted with the opposite party. While denying and controverting other allegations, dismissal of complaint was prayed.
3. Complainant tendered her affidavit Ex.CW1/A, copy of claim form Ex.C-1, copy of payment statement Ex.C-2, copy of ID card Ex.C-3, copy of X-ray Ex.C-4, copy of passport Ex.C-5, copy of letter regarding claim of insurance plan Ex.C-6, copy of insurance plan Ex.C-7, copy of e-mails Ex.C-8 and C-9, copy of credit card statement Ex.C-10, copy of e-mail Ex.C-11.
4. Opposite party tendered affidavit of Mr.Mohd.Azhar Wasi,Authorized signatory Ex.OP1, e-mail sent by the opposite party to provide credit card statement Ex.OP2, copy of payments and credits Ex.OP3, calculation sheet Ex.OP4, certified copy of schedule of Travel Insurance Ex.OP5, copy of letter dated 11.5.2015 Ex.OP6, postal receipt Ex.OP7, photocopy of cheque of Rs. 18579/- Ex.OP8.
5. We have carefully gone through the pleadings of the parties, arguments advanced by the complainant and ld.counsel for the opposite party and have appreciated the evidence produced on record by both the parties with the valuable assistance of the ld.counsel for both the parties.
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6. From the record i.e.pleadings of the parties and the evidence produced on record by both the parties, it is clear that complainant obtained travel plan from the opposite party on 22.4.2013. The complainant visited USA from 24.5.2014 to 27.6.2014. During her stay in USA, she suffered severe tooth ache and she consulted dental surgeon “Khalsa Dental Care of Gurdip Narula Dental Corporation”, 2850 Quimby Road # 145 San Jose, CA 95148 and the dental surgeon advised extraction of tooth on 18.6.2014. X-ray of the teeth was conducted and extraction was done , the complainant spent US $ 945 equivalent to Rs. 58,590/- on her treatment during her visit to USA i.e. within the policy period obtained by the complainant from the opposite party. Claim was lodged with the opposite party but the opposite party did not settle the claim of the complainant. Ld.counsel for the complainant submitted that all this amounts to deficiency of service on the part of the opposite party.
7. Whereas the case of the opposite party is that no doubt the complainant has been alleging that she submitted all the documents alongwith intimation to the opposite party. However, said allegation is not correct. Opposite party had been demanding credit card statement reflecting the amount paid in US $ 150, US $ 750 and US $ 45 from the complainant on telephone as well as through e-mail. But the complainant has not supplied the said credit card statement. However, during the pendency of this case , opposite party settled the claim case of the complainant on
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the ground that as per schedule of travel Insurance Ex.OP5 the maximum limit of sickness dental relief as dollar 300 . In the light of this upper limit, the amount was calculated by the opposite party as per calculation Ex.OP4 which comes to Rs. 18579/-. Opposite party sent the cheque of Rs. 18579/-, photocopy of which is Ex.P-8 to the complainant vide letter Ex.P-6 dated 11.5.2015 through registered post, postal receipt of which is Ex.P-7. As such the present complaint has become infructuous . ld.counsel for the opposite party submitted that now there is no deficiency of service on the part of the opposite party qua the complainant.
8. From the entire above discussion, we have come to the conclusion that complainant obtained Insurance policy i.e. Travel Guard Plan from the opposite party on 27.4.2014 bearing schedule No.JP218194, producer code No. 0009474018-020001. The complainant visited USA for the period from 24.5.2014 to 27.6.2014 as per copy of passport of the complainant Ex.C-5. During her stay in USA, complainant suffered severe tooth ache and consulted dental surgeon “Khalsa Dental Care” 145 San Jose CA 95148 and the dental surgeon diagnosed severe infection and advised extraction of tooth on 18.6.2014. Resultantly complainant got x-ray of the teeth and extraction of the same on 18.6.2014 and spent US $ 945 equivalent to INR 58590/-, bill of which is Ex.C-2. After return to India, complainant immediately informed the opposite party and lodged her claim within 24 hours i.e. on 27.6.2014, but the opposite party did not settle the claim of the
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complainant. They demanded the credit card statement reflecting the amount allegedly paid by the complainant. The complainant submitted all the documents demanded by the opposite party vide e-mail Ex.C-9 dated 22.8.2014 . Inspite of that the opposite party did not settle the claim of the complainant. Ultimately the opposite party settled the claim of the complainant on 6.4.2015 i.e. after a lapse of a period of about 8 months vide their letter Ex.OP4.
9. As per the schedule of the Travel Insurance in question Ex.OP5 the complainant is entitled to only US $ 300 for sickness dental relief. Resultantly the opposite party has settled the claim of the complainant on the basis of this schedule of Insurance Ex.OP5 at US $ 300. The opposite party was justified to settle the claim of the complainant at US $ 300 equivalent to INR 18579/- and the opposite party sent cheque Ex.OP8 of this amount of Rs. 18579/- to the complainant vide letter dated 11.5.2015 Ex.OP6. Opposite party is justified in settling the claim of the complainant at INR 18579/- vide e-mail Ex.OP4 and paid the cheque of this amount Ex.OP8 to the complainant and sent the same to the complainant through letter Ex.OP6. But this claim has been settled by the opposite party after the filing of the present complaint by the complainant. The complainant came back to India on 27.6.2014 and he lodged the claim with the opposite party immediately . But the opposite party settled the claim of the complainant and paid the amount through cheque vide letter Ex.OP6 dated 11.5.2015 i.e. after a lapse of a period of about one
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year. So the opposite party is certainly in deficiency of service in settling the claim of the complainant after a long period i.e. with delay of about one year.
10. Consequently we partly allow the complaint with costs and the opposite party is directed to pay compensation of Rs. 5000/- and litigation expenses Rs. 1000/- to the complainant within one month from the date of receipt of copy of this order. Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room. Complaint could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum.
15.7.2015 (Bhupinder Singh)
President
(Anoop Sharma) (Kulwant Kaur Bajwa)
/R/ Member Member
